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Innovative University of Auckland study could transform pacemakers

Researchers at the University of Auckland are investigating a new pacing paradigm that is expected to improve understanding of decreased cardiac efficiency in people with heart failure.

The study leader, Dr. Rohit Ramchandra says, “We have the potential to transform pacing strategies in cardiovascular disease globally. At present we simply do not know if the current fixed rate pacemaker is the best way to pace the heart,” he says. “We will test a novel pacemaker and pacing strategy to reinstate heart rate variability, which we predict will improve heart pumping efficiency.”

The study, known as the ‘Physiological pacing to improve cardiac output in heart failure’ was funded for three years by the Health Research Council (HRC) recently.

In New Zealand, the new research could benefit more than 80,000 people who are affected by heart failure. At present about one third of heart failure patients in New Zealand die within a year and those living with heart failure have a poor quality of life because even day to day tasks can leave them breathless.

“In the last decade there have been few new developments in heart failure management,” says Dr Ramchandra who established the Cardio-Renal Unit at the University’s Department of Physiology.

The new project will use animal models to determine the effects of breathing modulated pacing on cardiac output and heart blood flow; determine if breathing modulated pacing alters cardiac efficiency during left ventricle dysfunction; and determine if this new pacing strategy used long-term ultimately improves cardiac function.

According to Dr. Ramchandra, they have arranged a unique world-class research team with expertise from diverse disciplines: physiology, engineering, cardiology, mathematics and physics. He says. “There is international collaboration from the Universities of Bristol and Bath in the UK. We will investigate whether incorporating physiological feedback from respiration into our pacing strategy can improve cardiac output, heart blood flow and cardiac efficiency.”

The study also involves expertise from Dr Alona Ben-Tal at Massey University who will help develop and refine a mathematical model to optimise pacemaker parameter settings.

The data from this study will directly clarify the role of respiratory gated heart rate variability in mediating changes in cardiac efficiency and has the potential to positively impact pacing strategies in cardiovascular disease globally.